Our long-term goals are to increase smoking cessation in lesbian, gay, bisexual and transgender (LGBT) smokers and to understand the processes related to cessation and relapse in this underserved population. Conducted in two phases, the primary aim of this study is to compare the efficacy of a culturally targeted intervention versus a non-targeted intervention on smoking cessation outcomes in LGBT smokers. Further aims are to determine the effect of the ALA-CT intervention on individually mediated predictors of cessation and to explore the underlying cultural and psychosocial mechanisms through which the ALA-CT intervention has an impact (differential or not) on smoking cessation. In Phase I, we will use focus groups and a pilot trial to establish the cultural appropriateness and acceptability of the targeted elements of the intervention. In Phase 2, we will conduct a randomized smoking cessation trial to compare for the first time the efficacy of the American Lung Association's 'Freedom from Smoking Program' (ALA-FFS). Culturally targeted (ALA-CT) and Non-Targeted (Standard ALA-FFS) to LGBT smokers. The ALA-CT will consist of 7 culturally targeted (psychosocial and cultural) group counseling sessions combined with nicotine replacement and peer support. The contrast condition will be smokers who receive the non-targeted ALA-FFS program, nicotine replacement and peer support. The primary smoking cessation outcome will be point prevalence abstinence, i.e., no smoking, not even a puff, for previous 7 days, and will be assessed by Timeline Follow-Back derived measures for prolonged abstinence and point prevalence quit rates. Reported outcomes will be objectively verified [Carbon monoxide (CO) testing] at 1 month, 3, 6, 9 and 12 months follow-up to determine short and longer- term cessation outcomes. We will control for demographic variables that have known associations with smoking outcomes. PUBLIC HEALTH RELEVANCE: The purpose of this study is to develop and evaluate the benefits of culturally targeted smoking cessation intervention for lesbian, gay, bisexual and transgender smokers. Findings will contribute to the scientific literature on reducing smoking-related health disparities among underserved populations.